Provider Demographics
NPI:1659765428
Name:BARKOSKI, THOMAS JOHN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:BARKOSKI
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 LILAC DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4975
Mailing Address - Country:US
Mailing Address - Phone:815-216-0608
Mailing Address - Fax:
Practice Address - Street 1:8801 SCHNEIDER AVE APT 12
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1898
Practice Address - Country:US
Practice Address - Phone:815-216-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960043152255A2300X
IN36003012A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer